scholarly journals The Result of Treatment of Deep Neck Infection in Patients Referred According to Public Health System

2019 ◽  
Vol 99 (10) ◽  
pp. 627-632
Author(s):  
Chuan Cheepcharoenrat
Keyword(s):  
Public Health ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Public Health Systems ◽  
Results Of Treatment ◽  
Appropriate Treatment ◽  
Treatment Morbidity ◽  
The Cost

There are many factors that result in the treatment of deep neck infection (DNI). This study aims to compare the results of DNI treatment between referred and walk-in patients. This retrospective cohort study reviewed the data of 282 DNI patients. The peritonsillar abscesses and limited intraoral abscesses were excluded. The outcome of treatment such as duration of hospital stay, the expense of treatment, morbidity, and mortality were reviewed during staying in the hospital. A total of 282 patients were included in this study, there were 152 referred patients and 130 walk-in patients. Patients who were sent to have treatment results were not significantly different from those who had come directly to the hospital regardless of the length of stay, the cost of medical treatment, complications, and death due to complications with sepsis ( P = .013). However, the referred patients exhibited a risk to have sepsis 1.1 times more than the patients who went straight to the medical specialists (univariate analysis risk ratio [RR]: 1.1, 95% confidence interval [CI]: 0.8-1.3; P = .620). The results were confirmed in the multivariate analysis after adjusting for age, gender, diabetes, chronic renal failure, cirrhosis, and dental care. It was found that the risk to have sepsis in the “refer in” group was 1.1 times more than the other group (multivariate analysis RR: 1.1, 95% CI: 0.8-1.3; P = .658). In conclusion, the results of treatment in referred patients were not different from walk-in patients. Deep neck infection patients at hospitals that do not have a specialized doctor will receive appropriate treatment because of the effective DNI referral system according to public health systems. However, in referred patients, sepsis should be maintained prior to delivery.

scholarly journals Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 29
Author(s):  
Chia-Ying Ho ◽  
Yu-Chien Wang ◽  
Shy-Chyi Chin ◽  
Shih-Lung Chen
Keyword(s):  
Risk Factors ◽  
Airway Obstruction ◽  
Parapharyngeal Space ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Deep Neck Infection ◽  
Acute Epiglottitis ◽  
Neck Infection ◽  
Submandibular Space ◽  
Independent Risk Factors

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

Efficacy, Complication Rates, and Cost Effectiveness of Chemotherapy Plus Granulocyte Colony Stimulating Factor Conditioned Mobilisation of Peripheral Blood Haematopoietic Stem Cells in Over 150 Patients with Haematological Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2378-2378 ◽  
Author(s):  
Ian H Gabriel ◽  
Juliet Sharon ◽  
Eduardo Olavarria ◽  
Amin Rahemtulla ◽  
Edward Kanfer ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Peripheral Blood ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Organ Damage ◽  
Complication Rates ◽  
Median Cost ◽  
The Cost

Abstract Autologous stem cell transplantation (ASCT) remains the standard consolidation therapy for patients with multiple myeloma (MM) and chemosensitive relapsed lymphoma (r-Ly). Peripheral blood as a source of stem cells (PBSC) has largely replaced marrow and has the advantage of improved engraftment rates. PBSC are routinely collected following administration of chemotherapy in combination with GCSF. However, the resultant pancytopenia poses a significant risk to patients and additional chemotherapy prior to ASCT may lead to increased end organ damage potentially precluding future therapies (including ASCT). Novel agents can achieve PBSC mobilisation without the use of cytotoxics. In the advent of such drugs, we reviewed the efficacy of, and complications experienced by patients during PBSC mobilisation. We also analysed the cost implications of adverse events. Of 151 consecutive attempts, 13.2% of patients failed to reach our criteria in order to attempt pheresis (1 × 104 CD34 cells/ml). Of those achieving target and undergoing pheresis, 6% did not achieve an adequate cell dose for future ASCT (2 × 106CD34+cells/kg) giving an overall failure rate of 19.2%. Furthermore 17.9% failed to harvest our ideal of 4 × 106/kg (permitting &gt;1 ASCT procedure). Factors contributing to failure in achieving target CD34+ve PB count on univariate analysis were; &gt;2 lines of previous chemotherapy and occurrence of neutropenic sepsis (NS (p=0.002, and 0.005 respectively). These factors remained significant on multivariate analysis (RR: 4.4 and 6.2). These same factors also affected CD34+ cell yield on both univariate and multivariate analysis (RR: 3.3 and 4.6). No differences were seen between MM and r-Ly. Overall, the complication rate was 34.4%, with 24.1% of patients suffering NS requiring admission. The mortality rate was 1.3% (NS and intra-cranial bleed). Of those developing NS, only 52% eventually harvested sufficient cells, but with a median delay of 3 days. The median cost of PBSC collection was $17,381.46 ($1,978.97–$39,355.73). NS significantly increased the cost of mobilisation at a median cost of $25,532.95 vs $16,4921) (p=&lt;0.0001). Conclusion: Our results suggest that patients who are potential candidates for ASCT should be harvested as soon as they achieve remission to prevent failure following additional therapy upon relapse. One fifth of patients will fail. The risks associated with current mobilisation protocols are substantial, and also impact greatly on cost, particularly relevant in the current climate of economic probity. Therefore these data suggests that transplant centres should consider the use of non-myelosuppressive agents either in place of, or as a dose reduction strategy for autologous stem cell procurement.

scholarly journals Health equality, social justice and the poverty of autonomy

2017 ◽  
Vol 12 (4) ◽  
pp. 411-433 ◽  
Author(s):  
Christopher Newdick
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Systems ◽  
Public Health Care ◽  
Public Health Policies ◽  
Public Health Systems ◽  
Care Systems ◽  
Health Equality ◽  
The Cost ◽  
Lifestyle Diseases

AbstractHow does the concept of autonomy assist public responses to ‘lifestyle’ diseases? Autonomy is fundamental to bioethics, but its emphasis on self-determination and individuality hardly supports public health policies to eat and drink less and take more exercise. Autonomy rejects a ‘nanny’ state. Yet, the cost of non-communicable diseases is increasing to individuals personally and to public health systems generally. Health care systems are under mounting and unsustainable pressure. What is the proper responsibility of individuals, governments and corporate interests working within a global trading environment? When public health care resources are unlikely to increase, we cannot afford to be so diffident to the cost of avoidable diseases.

scholarly journals The Effect of the Quality of Health Services on the Satisfaction of Patients at the East Langsa Community Health Center

2021 ◽  
Vol 2 (1) ◽  
pp. 32-46
Author(s):  
Desy Murdiatama ◽  
Ahmad Rifai ◽  
Indah Anggraeni
Keyword(s):  
Public Health ◽  
Multivariate Analysis ◽  
Patient Satisfaction ◽  
Health Services ◽  
Health Center ◽  
Univariate Analysis ◽  
Community Health Center ◽  
Physical Evidence ◽  
Quality Of Health Services

Service quality and patient satisfaction are the two most important things in Community Health Center (puskesmas) services. This study aims to see the effect of the quality of health services on outpatient satisfaction at Langsa Timur Public Health Center, Langsa City in 2020. This type of research is a quantitative research which is an analytical survey with a cross sectional study approach. The population in this study were 2,116 people. A sample of 95 people using the Slovin formula. The analysis used is univariate analysis, bivariate analysis with chi-square test and multivariate analysis with linear regression test, measuring instruments used questionnaires and data processing using computerized with a significance level of P-Sign <0.05. The results of this study are based on the results of univariate analysis, as many as 64 people were dissatisfied and 31 people were satisfied. The results of multivariate analysis showed that physical evidence and responsiveness had an influence on patient satisfaction and physical evidence was dominant. The conclusion of this study is that there is an effect of physical evidence and responsiveness on outpatient satisfaction at Langsa Timur Public Health Center, Langsa City.

Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study

2017 ◽  
Vol 131 (9) ◽  
pp. 779-784 ◽  
Author(s):  
J Mejzlik ◽  
P Celakovsky ◽  
L Tucek ◽  
M Kotulek ◽  
A Vrbacky ◽  
...  
Keyword(s):  
Bacterial Culture ◽  
Infection Type ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retropharyngeal Space ◽  
Deep Neck Infection ◽  
Neck Movement ◽  
Neck Infection ◽  
Life Threatening ◽  
Deep Neck Infections

AbstractObjective:To identify deep neck infection factors related to life-threatening complications.Methods:This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.Results:During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).Conclusion:It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

scholarly journals Creating symptom-based criteria for diagnostic testing: a case study based on a multivariate analysis of data collected during the first wave of the COVID-19 pandemic in New Zealand

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nigel French ◽  
Geoff Jones ◽  
Cord Heuer ◽  
Virginia Hope ◽  
Sarah Jefferies ◽  
...  
Keyword(s):  
Public Health ◽  
Machine Learning ◽  
Multivariate Analysis ◽  
New Zealand ◽  
Sensitivity And Specificity ◽  
Respiratory Symptoms ◽  
Diagnostic Testing ◽  
Search Algorithms ◽  
The Cost ◽  
Automated Search

Abstract Background Diagnostic testing using PCR is a fundamental component of COVID-19 pandemic control. Criteria for determining who should be tested by PCR vary between countries, and ultimately depend on resource constraints and public health objectives. Decisions are often based on sets of symptoms in individuals presenting to health services, as well as demographic variables, such as age, and travel history. The objective of this study was to determine the sensitivity and specificity of sets of symptoms used for triaging individuals for confirmatory testing, with the aim of optimising public health decision making under different scenarios. Methods Data from the first wave of COVID-19 in New Zealand were analysed; comprising 1153 PCR-confirmed and 4750 symptomatic PCR negative individuals. Data were analysed using Multiple Correspondence Analysis (MCA), automated search algorithms, Bayesian Latent Class Analysis, Decision Tree Analysis and Random Forest (RF) machine learning. Results Clinical criteria used to guide who should be tested by PCR were based on a set of mostly respiratory symptoms: a new or worsening cough, sore throat, shortness of breath, coryza, anosmia, with or without fever. This set has relatively high sensitivity (> 90%) but low specificity (< 10%), using PCR as a quasi-gold standard. In contrast, a group of mostly non-respiratory symptoms, including weakness, muscle pain, joint pain, headache, anosmia and ageusia, explained more variance in the MCA and were associated with higher specificity, at the cost of reduced sensitivity. Using RF models, the incorporation of 15 common symptoms, age, sex and prioritised ethnicity provided algorithms that were both sensitive and specific (> 85% for both) for predicting PCR outcomes. Conclusions  If predominantly respiratory symptoms are used for test-triaging,  a large proportion of the individuals being tested may not have COVID-19. This could overwhelm testing capacity and hinder attempts to trace and eliminate infection. Specificity can be increased using alternative rules based on sets of symptoms informed by multivariate analysis and automated search algorithms, albeit at the cost of sensitivity. Both sensitivity and specificity can be improved through machine learning algorithms, incorporating symptom and demographic data, and hence may provide an alternative approach to test-triaging that can be optimised according to prevailing conditions.

scholarly journals Public health educational comprehensiveness: The strategic rationale in establishing networks among schools of public health

2017 ◽  
Vol 45 (7) ◽  
pp. 720-722 ◽  
Author(s):  
Robert Otok ◽  
Katarzyna Czabanowska ◽  
Anders Foldspang
Keyword(s):  
Public Health ◽  
Public Health Workforce ◽  
Public Health Systems ◽  
University Departments ◽  
Implementation Evaluation ◽  
Health Strategy ◽  
Comprehensive Curriculum ◽  
The Cost ◽  
Public Health Strategies ◽  
Behavioural Sciences

The establishment and continuing development of a sufficient and competent public health workforce is fundamental for the planning, implementation, evaluation, effect and ethical validity of public health strategies and policies and, thus, for the development of the population’s health and the cost-effectiveness of health and public health systems and interventions. Professional public health strategy-making demands a background of a comprehensive multi-disciplinary curriculum including mutually, dynamically coherent competences – not least, competences in sociology and other behavioural sciences and their interaction with, for example, epidemiology, biostatistics, qualitative methods and health promotion and disease prevention. The size of schools and university departments of public health varies, and smaller entities may run into problems if seeking to meet the comprehensive curriculum challenge entirely by use of in-house resources. This commentary discusses the relevance and strength of establishing comprehensive curriculum development networks between schools and university departments of public health, as one means to meet the comprehensiveness challenge. This commentary attempts to consider a two-stage strategy to develop complete curricula at the bachelor and master’s as well as PhD levels.

Clostridium difficileinfection: epidemiology, disease burden and therapy

2013 ◽  
Vol 154 (30) ◽  
pp. 1188-1193 ◽  
Author(s):  
László Gulácsi ◽  
Adrienne Kertész ◽  
Irén Kopcsóné Németh ◽  
János Banai ◽  
Endre Ludwig ◽  
...  
Keyword(s):  
Public Health ◽  
Health Economics ◽  
Disease Burden ◽  
Hungarian Literature ◽  
Medline Database ◽  
The Cost ◽  
Vancomycin Treatment

Introduction:C. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. C. difficile infection is a high-priority problem of public health in each country. The available literature of C. difficile infection’s epidemiology and disease burden is limited. Aim: Review of the epidemiology, including seasonality and the risk of recurrences, of the disease burden and of the therapy of C. difficile infection. Method: Review of the international and Hungarian literature in MEDLINE database using PubMed up to and including 20th of March, 2012. Results: The incidence of nosocomial C. difficile associated diarrhoea is 4.1/10 000 patient day. The seasonality of C. difficile infection is unproved. 20 percent of the patients have recurrence after metronidazole or vancomycin treatment, and each recurrence increases the chance of a further one. The cost of C. difficile infection is between 130 and 500 thousand HUF (430 € and 1665 €) in Hungary. Conclusions: The importance of C. difficile infection in public health and the associated disease burden are significant. The available data in Hungary are limited, further studies in epidemiology and health economics are required. Orv. Hetil., 2013, 154, 1188–1193.

The Experience in Organizing and Conducting the Analysis of Data on Nutrition of School-Aged Children in the Sverdlovsk Region within the Federal Public Health Promotion Project

2020 ◽  
pp. 10-17
Author(s):  
NA Moiseeva ◽  
IL Kholstinina ◽  
MF Knyazeva ◽  
TV Mazhaeva ◽  
OL Malykh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Rural Areas ◽  
Nutritional Value ◽  
School Meals ◽  
School Aged Children ◽  
Healthy Nutrition ◽  
Urban And Rural Areas ◽  
The Cost ◽  
Public Health Promotion

Introduction: Implementation of the Federal Public Health Promotion Project should raise awareness and develop skills of healthy nutrition in children, thus contributing to disease prevention. Our objective was to evaluate the results of pilot nutrition monitoring in school-aged children of the Sverdlovsk Region as part of the Federal Public Health Promotion Project and the National Demography Project. Results: We established that school meals were generally satisfactory: the rations complied with physiological needs of children in terms of their nutritional value, basic nutrients, energy, and distribution of calories by main meals. We noted differences in the cost and nutritional value of meals and the variety of dishes and foodstuffs used between urban and rural areas. As a rule, pupils have one or two school meals a day. Outside of school, their consumption of dairy products and fruit is limited. Conclusions: Our findings may promote the elaboration of municipal programs aimed, inter alia, at changing the amount of sugar and salt used in the manufacture of public catering products, the cost of dishes with a high content of sugar, saturated fats, and salt, and subsidies on healthy nutrition.

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